Predictors of severity and mortality of COVID-19 at a tertiary care
center in a Lower-middle income country
Abstract
Objective COVID-19 mortality and outcomes differ significantly across
the globe. Limited data exists from low-middle income countries (LMICs)
on risk-factors for COVID-19 severity and mortality. We describe the
clinical spectrum and predictors of mortality and severity of illness in
COVID-19 from a single center in Karachi, Pakistan. Methods
Retrospective cohort study of adults admitted with COVID-19 between
February-June 2020 were reviewed and logistic regression applied on
admission related risk-factors for severity and mortality. Results A
total of 445 patients [66.97% males, mean age 51.6 (18-91) years]
were admitted with PCR confirmed COVID-19 during the study period.
Asymptomatic and severe/critical disease occurred in 55 (12.36%) and
137 (30.79%) patients, respectively. The proportion of severe disease
increased with time and most (268, 60.22%) had ≥ 1 co-morbid. Disease
severity was associated with age ≥ 60 (OR:1.92), shortness of breath
(OR:4.43) , CRP ≥150mg/L (OR:1.77), LDH ≥ 500 I.U/L (OR:1.98),
Neutrophil to Lymphocyte ratio (NLR) ≥5 (OR:2.80) and unit increase in
serum creatinine (OR:1.32). All-cause mortality was 13%. Mortality was
associated with septic shock (AOR= 13.2), age ≥ 60 (AOR: 3.25), Ferritin
≥ 1500ng/ml (AOR: 3.78) and NLR ≥ 5 (AOR: 4.04). Conclusion We describe
the experience with COVID-19 from a tertiary-care hospital in a LMIC.
Our study found a comparatively low inpatient mortality, high proportion
of diabetics, and neutrophil to lymphocyte ratio of greater than 5 as a
predictor of both severity of illness and as poor prognostic marker in
COVID-19.